MRSA Demystified

Understanding and Avoiding the Superbug

Augusta is buggy year-round, so when David McGee found an ant bite on his hand, he didn’t think much about it. It itched, he scratched and then it popped, just like a typical ant bite might.

But instead of healing, the bite got worse, growing red and painful. Concerned, McGee visited his doctor, who prescribed antibiotics and took a culture. While he was waiting for the results, the bite continued to grow worse and worse, until one morning he woke up to find his entire hand and half his arm swollen.

The bite had become infected with community-associated MRSA, or methicillin-resistant staphylococcus aureus, a type of bacterial infection that is resistant to certain classes of antibiotics and can become serious if left untreated. McGee underwent surgery at Doctors Hospital to remove the affected area—a section two inches long, a half-inch wide and nearly a half-inch deep—and was also placed on IV antibiotics. Now, a month later, his hand is nearly healed, but he says, “I’ve never had it before and I don’t want it again.”

Over the past several years, community-associated MRSA has emerged in the public eye. School locker rooms and gyms have been shut down due to outbreaks of the superbug. Yet as awareness grows, so does misinformation.

What Is MRSA?

As it turns out, MRSA actually refers to two different strains of antibiotic-resistant bacteria. Hospital-acquired MRSA was first identified in the ’60s, soon after the advent of penicillin. Staph (the “S” of MRSA) became resistant to this family of antibiotics, and thus MRSA was born. This type of MRSA can cause serious systemic bloodstream infections that can be life-threatening, but it is primarily acquired within a hospital setting such as an ICU where patients are receiving high doses of antibiotics.

Community-associated MRSA first came on the scene in 2003—a new strain of the same bug that began showing up in people who had no connection to hospital settings.

The infection is most often found in gyms, locker rooms, daycare centers, schools—anywhere large groups of people congregate and share items. And while the infection can be serious if untreated, it is not typically considered life-threatening. In fact, according to Dr. Jim Wilde, an emergency room physician at Georgia Health Sciences Medical Center with additional training in infectious disease, CA-MRSA is currently fairly treatable with the right class of antibiotics. “Community-associated MRSA has very low invasiveness. It doesn’t tend to cause bloodstream infections,” he says.

Treating CA-MRSA

What the infection does tend to cause is skin infections and abscesses that typically look like a spider bite. In fact, many often confuse CA-MRSA with the bite of a brown recluse spider—which ironically, doesn’t even inhabit the CSRA. The abscesses can sometimes resolve on their own by “popping” and releasing pus. “The major treatment of CA-MRSA is drainage,” says Dr. Wilde. “It’s just nature…the infection comes to a boil, it ruptures and pus will come out. In many cases, that’s all you need.”

Those who are concerned should visit their physician, who can drain the abscess and prescribe antibiotics, if needed. (Never lance an abscess yourself, which increases risk of infection.)

Warning signs of more serious infection include an abscess that is large, with red skin tender to the touch, or an abscess that is expanding rapidly, in multiple sites or accompanied by fever. Patients with these symptoms should see a doctor immediately. “Fever is a manifestation of a systemic infection,” says Dr. Wilde. “You can get sepsis from CA-MRSA, you can get bone infections, pneumonia, even meningitis. It’s very uncommon, but those are possibilities.”

Still Dr. Wilde cautions the public not to panic. “They should be concerned about it…but physicians swim in a sea of MRSA every day…and I’ve never had a MRSA infection…This is not an infection that’s easy to acquire,” says Dr. Wilde. “If you cultured me right now, I might have MRSA on my skin, but as long as you take reasonable precautions…that’s a great way to prevent MRSA infections.”

Easy Ways To Prevent CA-MRSA

Those reasonable precautions come down to one thing—basic good hygiene. CA-MRSA is actually widely prevalent in the community. It’s estimated that one out of every three people carries staph bacteria on their body. CA-MRSA becomes a problem when at-risk settings—including schools, gyms and daycare centers—don’t properly clean equipment or practice good hygiene, allowing the bacteria to populate. And if the bacteria should enter any cut or scrape to the skin (such as a bug bite or even minute scrapes too small for you to notice), it burrows and becomes a typical CA-MRSA abscess.

According to Millie Schumacher, public relations director at the Family Y of Greater Augusta, she first heard of CA-MRSA in the mid-2000s while watching the news. At about the same time, an advisory came down from the national YMCA headquarters on what local facilities should do to help prevent infection. “Being a fitness center, we were conscientious about cleanliness before that, but we stepped it up,” she says. “(CA-MRSA) hasn’t been a problem for us that we’re aware of. However, we are aware that it is a concern, and it’s something we take very seriously.”

The Y has dedicated staff members and volunteers whose only job is to walk throughout the facility with a checklist to ensure equipment and gym spaces are properly maintained. Locker rooms and the daycare centers are wiped down once an hour, and staff also wipes down equipment regularly. Members, too, are encouraged to wipe equipment both before and after use. The Y uses hospital-grade disinfectant that kills 99.9 percent of bacteria.

In their childcare center and after-school programs, “Cleaning is second only to safety,” says Schumacher. “Certainly with children one of the ways any type of infection is spread is through contact, so we are very conscientious in our child care areas.” That includes cleaning toys after contact with a child, cleaning changing tables and keeping work areas that also double as snack areas for children clean.

It’s this type of sensible vigilance that demonstrate the basic good habits that schools, mainstream daycares, nursing homes and even home settings can establish to help prevent the spread of infections like CA-MRSA. “As a general rule, we don’t see large numbers of outbreaks…in part, because people are taking reasonable precautions,” says Dr. Wilde. “If you’re taking those precautions, you can minimize the risk.”

The Big Picture

Like hospital-acquired MRSA, the development of CA-MRSA can be traced to one simple action: overuse of antibiotics. As living organisms, bacteria adapt and change to ensure their longevity, and CA-MRSA is no exception. According to Dr. Wilde, the general public needs to better understand when it’s appropriate to use antibiotics—and when it’s not. “I urge the community not to use antibiotics against colds and flus—antibiotics are 100 percent not effective against viral infections,” says Dr. Wilde.

If the public continues to demand antibiotics for viral infections and continues to drive up bacterial resistance, it’s possible in the future that CA-MRSA will have adapted and will require hospitalization and IV antibiotics to treat every single case of the infection. “The inevitable is not here yet, but it’s on the way,” says Dr. Wilde. “And that’s why we’re trying not to use antibiotics if we can avoid them—like opening up the abscess and not sending them home on antibiotics. The less you use antibiotics, the less pressure there is for the bacteria to develop resistance.”

Danielle Wong Moores is an Augusta Freelance writer.

This article appears in the July 2012 issue of Augusta Family Magazine